Intracranial neurosarcoidosis

Area of Science:

• Neurology
• Radiology
• Pathology

Background:

• Intracranial sarcoidosis is a rare granulomatous disease affecting the central nervous system.
• Accurate diagnosis relies on integrating clinical, laboratory, and imaging findings.

Observation:

• Two cases of histologically confirmed intracranial sarcoidosis with distinct neuroradiological manifestations are described.
• Case 1: Periaqueductal granulomata causing aqueduct obstruction, showing homogeneous enhancement on CT.
• Case 2: Granulomatous infiltration of the fourth ventricle and cisterna magna causing hydrocephalus, without clear basal arachnoiditis on CT.

Findings:

• Granulomatous aggregations appeared as areas of slightly increased attenuation compared to normal brain parenchyma.
• Homogeneous enhancement post-contrast administration was observed in the granulomatous lesions.
• Computed tomography (CT) demonstrated obstructive hydrocephalus secondary to granulomatous infiltration.

Implications:

• Recognizable CT patterns can aid in the early diagnosis of neurosarcoidosis.
• Understanding these imaging features is crucial for timely treatment and management.
• This review contributes to the diagnostic criteria for neurosarcoidosis based on neuroradiological evidence.